ABSTRACT
Intensive addiction treatment environments present an outstanding opportunity to help trauma survivors with substance use disorder (SUD). Typically, such environments provide an array of group therapies, close monitoring by staff, and peers with whom to connect. However, only relatively recently has trauma become more accepted as a legitimate focus for work in addiction treatment. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.com> Website: < https://www.HaworthPress.com" xmlns:xlink="https://www.w3.org/1999/xlink">https://www.HaworthPress.com > © 2006 by The Haworth Press, Inc. All rights reserved.]
Intensive addiction treatment environments present an outstanding opportunity to help trauma survivors with substance use disorder (SUD). Typically, such environments provide an array of group therapies, close monitoring by staff, and peers with whom to connect. However, only relatively recently has trauma become more accepted as a legitimate focus for work in addiction treatment. The old message was, “Get clean and sober first, and then we’ll help you with co-occurring issues such as trauma.” In some places, this message is still heard. The 154new message, widely recommended at this point (K. T. Brady, 2001; Donovan, Padin-Rivera, & Kowaliw, 2001; Evans & Sullivan, 1995; Miller & Guidry, 2001; L. M. Najavits, 2002a; Ouimette & Brown, 2002; Triffleman, 1998) is, “Let’s help you with trauma-related problems as well as SUD.” This integrated approach (treating SUD and co-occurring mental illness at the same time), is believed to be more helpful both for the SUD and for mental illness. Moreover, a handful of studies thus far have evaluated outcomes for psychosocial treatments that were designed to treat both trauma problems and SUD at the same time. The bottom line? In all of them, clients overall were helped, not harmed (e.g., K. Brady, Dansky, Back, Foa, & Caroll, 2001; Donovan et al., 2001; Morrissey et al., under review; L. M. Najavits, Schmitz, Gotthardt, & Weiss, in press; L. M. Najavits, Weiss, Shaw, & Muenz, 1998; Triffleman, Wong, Monnette, & Bostrum, 2002; Zlotnick, Najavits, & Rohsenow, 2003). Also, the few studies that compared manual-based treatment to addiction “treatment as usual” showed the former to be significantly more helpful (Hien, Cohen, Miele, Litt, & Capstick, 2004; L. M. Najavits, Gallop, & Weiss, under review).
Yet there are notable challenges to help addicted survivors of trauma. Both for clients and for staff, a variety of dilemmas may emerge. In this paper, several broad themes will be identified.
